20 May 2020 | News
Medical management through early diagnosis and timely treatment through Drugs and a new class of Biologics can help patients control their disease effectively
Wellness 365, a community representing leading Indian medical professionals and practitioners, has announced that India has an estimated 1.5 million patients affected by the Inflammatory Bowel Disease (IBD), putting the country second only to USA with 1.6 million patients. Also, these number are rising at a high single digit rate, as Indians have a greater than average risk of getting this disease.
To educate people and help them receive appropriate medical intervention, the platform has launched a month-long campaign #ManageYourIBD, in association with leading Indian gastroenterologists from the key metro cities. The campaign was launched in support of the May 19, 2020, the World IBD Day. This will complement the global movement with hashtag #MakeIBDwork.
Inflammatory Bowel Disease is an intestinal disorder which involves prolonged inflammation of the digestive tract and if left untreated can lead to irreversible damage of the intestines involving conditions like intestinal obstruction, intestinal perforation, and a higher risk of colorectal cancer. IBD is not cured by regular medication and requires the involvement of a specialist often requiring long-term management. Broadly there are two types of IBD’s - Ulcerative Colitis (UC) and Crohn’s Disease (CD).
Explaining the symptoms, Dr. Rudrajit Sinha, Gastro-Intestinal Surgeon, Advanced Laparoscopy & Robotics, The Calcutta Medical Research Institute, Kolkata, says, “An IBD patient suffers from persistent abdominal cramps with irregular bowel habits and occasional passage of mucus and blood in stools. The disease is often associated with unexpected weight loss and the patient is resistant to usual treatments for stomach ailments.”
The diagnosis for IBD’s can be challenging, explains Dr. Ajay Choksi, Consultant and Head, Dept. of Gastroenterology, Nanavati Hospital, Mumbai “Many self-limited illnesses like bacterial infections and protozoal illnesses can mimic IBD on gross endoscopic and histologic findings but do not last beyond a month. Very often it may be impossible to differentiate between tuberculosis and Crohn’s disease which is when therapeutic trials and follow ups may be required for a precise diagnosis. Timely and early diagnosis increases the probability of inducing easy and durable remission of the disease. Vast majority of the patients can be successfully managed with medications.”
Elaborating on the risks and the available treatment options, Dr. Ajay Bhalla, Director & Head Gastroenterology, Fortis Hospital, Noida, says “Medical management remains the key modality in the treatment of inflammatory bowel diseases. In case of ulcerative colitis, need for surgical intervention is low at about 6% for Indian patients while the worldwide average being about 10-12%. Medical management with drugs like 5-ASAs, steroids and azathioprines and use of biologics gives effective outcomes.”
“However, in case of Crohn’s disease, the patient can end up with conditions like intestinal crystallization or recurrent obstruction, where surgery may be required. It is seen worldwide and in India too that about one third of patients with Crohn’s disease require surgery at some point of time. Rest of the patients are successfully managed with medical management through drugs like steroids and azathioprines and now the use of biologics which would change the whole course of treatment. As the use of biologics becomes more common in India, I guess the requirement of surgery will go down further”, he added.
Delving into the impact of the disease, if it is left untreated, Dr. Amarender Puri, Vice Chairman, Institute of Digestive and Hepatobiliary Sciences, Medanta, Gurugram, “There is a definite risk of colorectal cancer if IBD is left untreated. The risk is in direct proportion to the duration of the disease. It is negligible during the first 8-10 years but steadily increases thereafter. Currently the risk is thought to be about 10% among those with the disease for 25-30 years. This risk is particularly much more among patients who have been irregular with their treatment vis a vis those who are fully compliant. Additionally, untreated disease leads to long standing anaemia and protein loss from the body.”
Interestingly, factors like the socioeconomic and demographic classification play a role in the incidence of the disease, explains Dr. Piyush Ranjan, Sr. Consultant, Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Delhi, “In general, IBD is more common among urban population and the higher socioeconomic groups. Both males and females have an equal chance of having ulcerative colitis. However, in case of Crohn’s disease, females have a slightly higher preponderance. “
Lack of awareness makes things worse:
Lack of awareness remains a key barrier in helping people get the correct diagnosis and receive the right treatment. Ignorance often leads to the patient being treated for common problems like upset stomach, and even tuberculosis, while the issue is completely different. The debilitating effects of not diagnosing early is a life-threatening hazard which is also financially and emotionally draining for the family. Heightened awareness and early diagnosis can go a long way in helping people with the IBD conditions.